The present invention relates to arthroscopic tissue repairs such as rotator cuff repairs, Bankart repairs and capsulorrhaphy. In particular, the present invention relates to an intraarticular drill guide for use in performing such repairs.
Surgeons have long recognized the advantages of arthroscopic repairs over the traditional open surgical repair. An open repair requires a relatively large incision which raises the prospect of complications due to restriction of shoulder motion, pain, risk of infection, length of hospital stay and cosmesis (small scars). Arthroscopic surgery is performed through small incisions or holes which permit elongated instruments to enter the joint being operated upon. An arthroscope is used through one of these holes into the joint to permit visualization, while other holes are used for the instruments to enter the joint.
In performing a tissue repair, it is often necessary to anchor tissue to a bone. There are many techniques which use items such as metal anchors, tacks or staples to secure tissue to bone. Such items can cause damage to a joint if they were to break loose. Therefore, alternative methods using sutures to secure tissue to bone are appealing. A suturing method for capsule repair is described in Caspari, R. B., "Arthroscopic Reconstruction for Anterior Shoulder Instability," Techniques in Orthopedics 3(1) 59-66, 1988, the disclosure of which is hereby incorporated by reference herein. A suture punch is used to place the sutures about the tissue to be affixed to the bone. Caspari drills a hole from the front side of the bone at the site of the tissue repair. The Caspari arthroscopic drill guide is affixed against the bone only on the front side. The lack of control over the exit hole of the drill present a risk of injury to neurovascular structures. The technique requires that sutures be tied over a muscle. This limits muscle function and requires that permanent sutures be avoided. Instead, absorbable sutures last only for a few weeks and thus do not allow as strong a repair. In an open surgery, sutures can be used to hold down the repaired tissue against the bone without wrapping over adjoining muscle such that non-absorbable permanent sutures may be used.
Harryman II, D. T. et al., "Arthroscopic Labral Repair to the Glenoid", Arthroscopy, Vol. 10, No. 1, pp. 20-30, 1994, discloses a technique that may be used for Bankart repairs but not rotator cuff or capsulorrhaphy. An arthroscopic intraarticular drill guide is shown for drilling a hole across a corner of a bone. The technique is difficult to perform.